universal health care law philippines essay

Implementing Universal Health Care (UHC) in the Philippines: Is the Glass Half Full or Half Empty?

02 August 2021

This piece originally appeared in P4H here . It was written by Christian Edward Nuevo, Maria Eufemia Yap, Matt Boxshall, and Nirmala Ravishankar. 

Primary health care (PHC), first introduced through the Alma Ata Declaration of 1978, emphasizes that addressing health needs should be people-centered and multi-sectoral in approach. The recently passed Universal Health Care (UHC) Law in the Philippines puts PHC center stage through reforms aimed to improve health system performance. While the vision is laudable, making it happen is challenging. This article offers early learnings from the implementation of the UHC Law drawn from ThinkWell Philippines’ program of technical assistance and policy research to support the Department of Health (DOH) and the Philippine Health Insurance Corporation (PhilHealth)¹. We identified key opportunities and challenges created by the UHC Law against the three main pillars of strengthening PHC [1]. The UHC vision will have to be progressively realized through paradigm shifts, communication interventions, and a clear and strategic roll out plan.

Philippine Health Sector Reform: The UHC Law

Health sector reform in the Philippines has been accelerated by the passage of Republic Act 11223, more commonly known as the UHC Law [2]. This landmark piece of legislation seeks to revitalize health care through a whole-of-system, whole-of-government, whole-of-society, people-centered approach. It recognizes that health systems are naturally complex, dynamic, and adaptive. The legislation acknowledges that improving health system performance requires sustainable, wholesale changes [3]. The pillars of PHC underpin the entire UHC reform [1][2].

PHC and the UHC Law

The 2030 Agenda for Sustainable Development as well as other landmark resolutions [4] all champion the crucial role of PHC in achieving responsive and resilient country health systems [5]. The UHC Law is anchored on the three main pillars of PHC [6] in the following way:

• Primary care and essential public health functions as the core of integrated health services:  The UHC Law seeks to re-integrate the Philippines’ highly devolved governance system into province-wide health systems. These integrated provincial health systems promise more efficient use of resources and delivery of comprehensive care. Providers are encouraged to consolidate into health care provider networks, capable of delivering a range of services, grounded on a strong primary care base. PhilHealth is expanding its currently limited primary care benefit to a new package called “ Konsulta ”², with expanded rates and service inclusions, accessible to all membership types. Health care provider networks will be contracted by PhilHealth as one entity, aligning their incentives and accountabilities, and promoting continuity of care. Regrettably, the law does not mandate this re-integration. Resistance to change, and politics of intervening laws such as the Local Government Code stand in the way. Municipal mayors stand to lose authority over their health spending, personnel, and resources, and will only influence these as a member of the health board. Adequacy and supply-side readiness of health facilities, as well as financial constraints and the sustainability of PhilHealth are still prevailing realities [7][8][9].
• Empowered people and communities : With the UHC Law, all Filipinos are automatically members of PhilHealth, and are immediately entitled to benefits. Families and households are also given the freedom to choose the primary care provider they prefer and trust. Patient involvement in key decision areas is enhanced through representation in the Health Technology Assessment Committee that decides on benefit inclusions, and in the provincial health board that develops and monitors the province health plan. These opportunities for patients to directly influence matters concerning their own health contribute to a system that is truly responsive. However, patient knowledge is coming from a rather weak base. Data shows that for PhilHealth covered indigent families, only 53% knew of their entitlement for no balance billing, and around 39.6% are misinformed of their sponsorship [8]. This and other knowledge gaps present real challenges in affording people genuine participation even in institutionalized processes.
• Multi-sectoral policy action:  The UHC Law mandates the institutionalization of cooperative intergovernmental decision-making and implementation, particularly on areas such as health impact assessment, health professional education, and monitoring and evaluation of health system performance. The private sector is also enjoined to  respond to service delivery needs as health care provider networks, and to generate evidence together with the academe through data sharing and commissioning of relevant health policy and systems studies. Through these more inclusive and regular stakeholder engagement processes, strategic complementation with partners within and outside government is encouraged. Still, differences in perspectives and interests are among the greatest hurdles that affect cooperation and resource allocation. For one, adequacy of PhilHealth benefit package rates are continuously criticized [10], particularly by for-profit private facilities that do not enjoy the government subsidy afforded to public facilities. Even between government units, changes in processes meant to improve efficiency of one agency, may result to negative effects for another. When the Department of Budget and Management (DBM) transitioned to a new budgeting mechanism, it resulted to a 28% decrease in DOH appropriation from 2018 to 2019 [11].

Key areas for priority action

One of the biggest prerequisites in this reform process is a  shift in governance paradigms . The UHC reform requires provincial governments to be more accountable for care of their constituents and management of their health systems. They must reduce dependence on current national government support on personnel deployment, commodities, and infrastructure investments. Provincial governments must work to contextualize the benefits of integrating into province-wide health systems and health care provider networks, and rally support from people and providers within their jurisdiction. Central offices, on the other hand, should pivot back to their role of being technical stewards of the health sector, crafting strong policies, standards, and regulatory thrusts. These transitions from old to new ways need to be championed by the Department of Health, generating buy-in from other government agencies to ensure a genuine whole-of-government approach.

As new policies and guidelines are formulated,  strong communication and promotion interventions  must be pursued   by both the national and local governments. Patients need to be informed of all their entitlements, and the merits of living healthy lifestyles. Likewise, health care providers must understand the need for instituting strong gatekeeping mechanisms and facilitating synergistic relationships between primary and specialty practitioners. By engaging various stakeholders and communicating a compelling value proposition, key players will better understand their respective roles, leading to greater alignment with the UHC agenda.

Finally,  a clear, strategic, year-on-year rollout chronology  towards achieving the vision for UHC should be laid out in a transparent manner. Sequencing of reforms should start with generating clear demand for primary care through patient empowerment and incentive schemes for providers. This can drive the necessary motivation for the public sector to build capacity, and similarly attract the private sector to participate and coordinate. By committing to a clear plan of action, the Philippines DOH can build confidence amongst all stakeholders, public and private, local and national, and across government. Clarity of vision will be essential to deliver on the promise of UHC in the Philippines.

¹  These activities are part of the Strategic Purchasing for Primary Health Care project supported by the Bill & Melinda Gates Foundation and implemented by ThinkWell. For more information, please visit our website . For questions, please write to us at [email protected] l.

² An expanded primary care benefit package known as PhilHealth Konsulta (PhilHealth Konsultasyong Sulit at Tama) to cover all Filipinos and to ensure access to essential, preventive, promotive, and curative services.

• World Health Organization. 2019. Primary health care towards universal health coverage. In: Seventy-second World Health Assembly, 1 April 2019. Geneva: World Health Organization. Available from:  https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_12-en.pdf  [cited 2020 Feb 08].
• Republic of the Philippines. 2019. Republic Act 11223. An Act Instituting Universal Health Care for All Filipinos, Prescribing Reforms in the Health Care System, and Appropriating Funds Therefor.
• Fattore G, Tediosi F. 2013. The Importance of Values in Shaping How Health Systems Governance and Management Can Support Universal Health Coverage. Elsevier: Value in Health 16, S19-S23.  http://dx.doi.org/10.1016/j.jval.2012.10.008
• 2012 UN Resolution on Universal Health Coverage, 2018 Declaration of Astana, 2019 World Health Assembly
• World Health Organization. 1978. Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR.
• Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. 2018. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 11;6(11):e1196–252.  http://dx.doi.org/10.1016/S2214-109X(18)30386-3  pmid: 30196093
• Bredenkamp C, Gomez V, Bales S. 2017.  Pooling Health Risks to Protect People: An Assessment of Health Insurance Coverage in the Philippines.
• Dayrit MM, Lagrada LP, Picazo OF, Pons MC, Villaverde MC. 2018. The Philippines Health System Review. Vol. 8 No. 2. New Delhi: World Health Organization, Regional Office for SouthEast Asia. Available from:  http://apps.searo.who.int/PDS_DOCS/B5438.pdf  [cited 2020 Feb 10].
• Romualdez JR, Rosa J, Flavier J, Quimbo S, Hartigan-Go K, Lagrada L, et al. 2011. The Philippines Health System Review. Vol. 1 No. 2. Manila: World Health organization, Regional Office for the Western Pacific.
• Picazo OF et al. 2015. A Critical Analysis of Purchasing of Health Services in the Philippines: A Case Study of PhilHealth. Philippine Institute for Development Studies. Discussion Paper Series No 2015-54.
• Department of Health. 2019. Budget Briefer FY 2019. Health Policy Development and Planning Bureau. Available from:  https://www.doh.gov.ph/publication/serials/2019-Budget-Briefer  [cited 2020 Feb 10].

View all Editorials articles

Share this article

• Top Stories
• ELECTIONS 2025
• #ANONGBALITA
• Economy & Trade
• Banking & Finance
• Agri & Mining
• IT & Telecom
• Fightsports
• Sports Plus
• One Championship
• TV & Movies
• Celebrity Profiles
• Music & Concerts
• Digital Media
• Culture & Media
• Health and Home
• Hospitality
• Accessories
• Motoring Plus

Real Estate

• Environment and Sustainability

The Philippines’ long and arduous journey toward achieving Universal Health Care or UHC reached a significant milestone when Republic Act No. 11223, otherwise known as the Universal Health Care Act of 2019, was signed into law by President Rodrigo Roa Duterte on February 20, 2019. The UHC’s overarching objective is to provide all Filipinos with equitable access to quality and cost-effective health care services without causing financial hardship.  

The UHC Act by far provides the most comprehensive policy as well as the enabling environment for such a vision to happen in a progressive manner. The last 50 years had been marked by various attempts to achieve such a profound and collective aspiration for the health of the Filipino especially of the underprivileged and the marginalized. 

It all started in the 1960s when a group of doctors introduced the MARIA (Medical Aid to Rural Indigents Areas) Project, considered the precursor of the Medical Care Plan that was created through RA No. 6111 in 1969. A quarter of a century hence, the National Health Insurance Program under the administration of the Philippine Health Insurance Corporation (PhilHealth) was created through RA No. 7875 on February 14, 1995.

The NHIP signaled an era that upheld financial protection for all Filipinos so that everyone can access needed health care services that are available, accessible, adequate and acceptable. 

The rest is history.

As we mark PhilHealth’s 25 years of enduring service to the Filipino, we invite the nation of 108 million to look back, reflect and celebrate important milestones in the last 25 years that nurtured PhilHealth to what it is today… Pinatatag na Segurong Pangkalusugan sa Bawat Filipino!  

Come together: Consolidation of the Medicare programs 

A couple of years after PhilHealth took the reins from the former Philippine Medical Care Commission, it assumed administration from and started with the consolidation of separate health insurance programs of the Government Service Insurance System in 1997, Social Security System in 1999, and the Overseas Workers Welfare Administration in 2005 into one National Health Insurance Program. The historic integration led to the unification and subsequent increase in benefit levels as well. 

The First Amendment: Republic Act 9241

Signed on February 10, 2004, this law revises pertinent provisions of RA No.7875 which resulted to the merging of OWWA Medicare with the NHIP, enhancement of members’ benefits, and strengthening enrollment of indigent members into the program through sponsorship. 

More power to you: The Second Amendment 

RA No. 10606 amended RA No. 7875 to better the member experience through simplified registration process, and to ensure full coverage of the poor and the marginalized. This also enhanced the powers of PhilHealth in implementing the program by strengthening its quasi-judicial functions. 

Small step, big leap for the health of the people: Introducing the primary care benefit 

Launched in 2012, the Primary Care Benefit 1 (PCB1) provides primary preventive services, diagnostics and medicines to specified diseases to select members. It was further expanded in 2017 through the Expanded Primary Care Benefits (ePCB) and extended coverage to members in the Formal Economy, Lifetime Members and Senior Citizens. 

The shift towards efficiency: The All Case Rates 

In 2013, PhilHealth shifted to case-based payment to make benefit payments predictable and equitable based on patients’ medical condition – a complete departure from the Fee-for-Service that is known to encourage wastage. Initially introduced in 2011 for selected cases, the system has set benefit amounts for more than 4,000 medical conditions and surgical procedures, making it easy for members to know exactly their PhilHealth entitlements.

Covered from A-Z: The Z Benefits

First introduced in 2012, this new set of benefits covers certain cases that are catastrophic and financially draining for afflicted members especially the underprivileged. Among the packages created are kidney transplantation worth P600,000, coronary artery bypass graft at P550,000, acute lymphocytic/lymphoblastic leukemia at P500,000, and surgery for tetralogy of fallot for children at P320,000. In 2018, the packages were expanded to include cases of children with disabilities. 

“Peace of mind during sickness”: The No Balance Billing Policy

This policy provides that no other fees or expense shall be charged against the patients above and beyond the case rates for the entire confinement. This was initially introduced to indigent and sponsored patients, and was later extended to Kasambahays, Senior Citizens and Lifetime Members in 2017.

No coverage? No worries: Point-of-Care and Point-of-Service 

First introduced in 2013, the POC ensures that the poor and near poor confined in government hospitals are given coverage after having been assessed as financially incapable. Subsequently in 2017, the POS was introduced to strengthen the POC, which  include patients who are financially capable by permitting them to pay a year’s worth of contribution to be able to avail of social health insurance.

Because we care: The arrival of the P-CARES

In 2012, a roster of competent registered nurses called Customer Assistance Relations and Empowerment Staff (CARES) were deployed to accredited facilities to assist members in benefit availment. In 2015, the PhilHealth CARES won in the Philippine Government Best Practice Competition by the Development Academy of the Philippines; and was given the Customer Service and Transformation Excellence Award during the 33rd ASEAN Social Security Association (ASSA) Board Meeting in Pasay City, Philippines.

Remembering the needy and marginalized

To further extend reach to the marginalized sectors, PhilHealth partnered with Department of Social Welfare and Development to ensure that orphans, abandoned and abused children and other minors are provided with social health insurance. The Kasambahays and senior citizens followed suit by virtue of special laws, while dual citizens and foreign nationals living in the country were also granted access to health insurance.

No papers, no lines… just keep online

Web-based application Electronic Premium Remittance System (EPRS) was first introduced to employers in 2010 to replace the manual reporting system that they are required to do on a monthly basis. In 2015, the EPRS included an online payment facility which contributed to greater ease in doing business in the country in terms of easier payment of taxes. The feat was noted by no less than the World Bank in its Doing Business Report 2017 and duly cited by the National Competitiveness Council. 

Efficient benefit entitlement 

The HCI Portal established a linkage between PhilHealth and its accredited facilities through online connection, simplifying and making benefit eligibility checking a breeze and real time – effectively cutting down time as well as eliminating the need to submit paper requirements. This electronic gateway took off in 2014.

In just a few clicks: Member Inquiry Facility

This facility allows members to verify online information contained in their membership profile and the summary of their contributions through an online platform linked to the PhilHealth website which was launched during PhilHealth’s 20th anniversary in 2015.

We want to make it fast: Electronic claims 

This aims to provide the health care institutions to submit claims electronically and track the status of their claim reimbursements with the help of technology providers or in-house developed software solutions duly certified by PhilHealth. The new system has enabled hospitals to transmit claims with ease, and be reimbursed faster. 

We have an App: All Case Rates Search Engine and Mobile Application 

Found in the homepage of PhilHealth’s website, this facility assists members and even providers in determining the amount that PhilHealth pays for medical conditions and procedures. This online platform was created in 2015 and can be downloaded and used by Android mobile phone users even offline.

PhilHealth Action Center 

The PhilHealth Call Center was established in 2011 to efficiently manage the volume of members’ requests for timely information about their entitlements. To be more relevant, it expanded to a round-the-clock Action Center which administers customer queries on multiple channels which include e-mails, SMS, and the social media as well.

We are certified! 

PhilHealth also takes pride being duly ISO 9001:2008 certified, the initial certification of which was awarded to selected offices in 2014, and subsequently granted to all its regional offices nationwide in 2015. In July 2018, PhilHealth leveled up to ISO 9001:2015 following the recommendation of third party auditor Anglo Japanese American (AJA) Registrars Inc.

Investing on the youth

PhilHealth has initiated a full scale partnership with the Department of Education in order to integrate its social health insurance module using the PhilHealth Learner’s Manual in the basic to tertiary education curriculum. The program was pilot tested with tertiary level students of Sultan Kudarat Educational Institution in Tacurong, Sultan Kudarat in 2015.

Quality matters

The enhanced Benchbook for use of accredited health care providers aims to ensure that only quality service is provided to the members. First adopted in 2005 and fully implemented in 2010, the Benchbook is an innovative approach where PhilHealth shifted from a purely accountable framework to that of continuous quality improvement. 

We are now everywhere

Launched in 2012, the PhilHealth Express are frontline desks conveniently located in malls and other high-traffic areas aimed at providing timely and quality frontline services to members who maximize their time fulfilling their health insurance concerns even while shopping, dining and bonding with families and friends, or in between errands.

Reaching you: The Alaga Ka Campaign

Alaga Ka (“Alamin at Gamitin”) is an integrated information campaign which aims to empower PhilHealth members to know their rights and privileges. Launched in March 2014, Alaga Ka is being conducted through roadshows in various barangays and local communities where members at the grassroots level can easily converge to avail of information and other services.  

Hall of Famer: ARTA Frontline Service Champion

In 2018, the Civil Service Commission (CSC) has conferred the Seal of Excellence Award (SEA) Hall of Famer to PhilHealth for earning the most number of SEAs from 2010 to 2016 – a testament to PhilHealth’s abiding commitment to excellence in customer relations and service.   

Most Trusted Government Agency

PhilHealth was named most trusted social protection agency based on the 2017 and 5th Philippine Trust Index conducted by communications agency EON Group. PhilHealth garnered a total of 95 percent trust rating among various government agencies that include social protection entities.

Increasing Social Media presence

With increasing digital access among Filipinos, PhilHealth deemed it appropriate to go where most of its members are, enabling it to reach millions of members locally and overseas to inform them of new developments about the program. To date, its official Facebook page (PhilHealth Official) has more than 1.2 million followers who benefit from constant stream of information either from art card posts or through livestreaming facility “Facebook Live” which discusses specific topics at length.

Our ultimate vision: Universal Health Care 

As PhilHealth welcomes the new era of reforms, it shifted its gears to the challenges of UHC. Real and profound changes will be felt by Filipinos in a progressive fashion starting with the automatic inclusion of all Filipinos into the NHIP, implementation of immediate eligibility to the benefits, introduction of a strengthened primary care package that entitles everyone regardless of their health status, among others.

 More reforms are on their way, and PhilHealth fully commits to take on every challenge as the nation endeavors to progressively realize Universal Health Care for the generations of today and of tomorrow. 

• Universal Health Care

LATEST NEWS

Bsp asks gcash to refund unauthorized deductions, pnp: quiboloy taken to hospital due to chest pains, philippines gdp expanded 5.2% in third quarter of 2024, philippines unemployment rate dropped to 3.7% in september 2024, popular articles, green logistics, coinversations, da launching kadiwa rice program in major markets, adb teams up with mastercard to mobilize msme funding.

• Economy & Trade
• Banking & Finance
• Agri & Mining
• IT & Telecom

On the Road

• Monitoring Plus
• Travel Features
• Travel Reels
• Travel Logs

Entertainment

• TV & Movies
• Music & Concerts
• Culture & Media
• Environment & Sustainability
• Users Agreement

© All Rights Reserved. 2024 | Manila Standard | Developed by Neitiviti Studios

• Special Pages